Provider Demographics
NPI:1922123306
Name:MENDIGUTIA, CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:MENDIGUTIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2241
Mailing Address - Country:US
Mailing Address - Phone:786-786-4888
Mailing Address - Fax:786-677-8888
Practice Address - Street 1:6602 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2241
Practice Address - Country:US
Practice Address - Phone:786-786-4888
Practice Address - Fax:786-677-8888
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist